Tratamiento inhalatorio en la crisis asmática severa
Palabras clave:
ASMA, ENFERMEDAD AGUDA, ESTADO ASMATICO, AEROSOLES, BETA AGONISTAS ADRENERGICOS, ANTAGONISTAS COLINERGICOS, CORTICOSTEROIDES, TERAPIA POR INHALACION DE OXIGENO
Resumen
Se realiza una revisión sobre el tratamiento inhalatorio de la crisis asmática. La inhaloterapia está ampliamente difundida en la práctica médica habitual, implicando importantes costos económicos. Sin embargo, se estima a nivel mundial que hay una administración inadecuada en un porcentaje importante, lo que resulta en fracasos terapéuticos y gastos innecesarios. Esto adquiere relevancia cuando se conoce el aumento de la mortalidad por asma en las últimas décadas y se detecta que tanto los pacientes como los médicos y paramédicos carecen mayoritariamente de los conocimientos básicos y habilidades para su adecuado manejo. Se establecen los objetivos de la inhaloterapia y se consideran sus aspectos fundamentales (físicos, generadores de aerosoles, farmacología). Se estudian y comparan los distintos sistemas de generación de aerosoles y también se analizan los diferentes fármacos inhalados. Se exponen con detalle los beta agonistas, anticolinérgicos y corticoides en sus formas inhaladas. También se presentan otros tratamientos inhalatorios no tradicionales como el sulfato de magnesio y una mezcla gaseosa heliox. En los distintos tópicos se recurre en lo posible a revisiones sistemáticas o metaanálisis para establecer preferencias o elegir tratamientos. Los autores proponen algunas estrategias terapéuticas avaladas en su experiencia, documentada en la bibliografía aportada.
Citas
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2) Fink JB, Dhand R. Aerosol therapy:Preface. Respir Care Clin North Am 2001; xi-xii.
3) Rodrigo C, Rodrigo GJ. Inhalotherapy in nonintubated acute asthma patients. In:Hall JB, Corbridge T, Rodrigo C, Rodrigo GJ, ed. Acute asthma. Assessment and Management. New York:McGraw-Hill, 2000:161-78.
4) Rodrigo GJ, Rodrigo C. Aerosol and inhaled therapy in treatment of acute adult airway obstruction in the emergency department. Respir Care Clin North Am 2000; 7(2):215-31.
5) Dolovich MB, Fink JB. Aerosols and devices. Respir Care Clin North Am 2001; 7(2):131-73.
6) Morrow PE. An evaluation of the physical properties of monodisperse and heterodisperse aerosols used in the assessment of bronchial function. Chest 1981; 80(Suppl):809-13.
7) Zanen P, Go LT, Lammers JW. Optimal particle size for beta 2 agonist and anticholinergic aerosols in patients with severe airflow obstruction. Thorax 1996; 51(10):977-80.
8) Laube BL. In vivo measurements of aerosol dose and distribution:clinical relevance. J Aerosol Med 1996; 9(Suppl 1):S77-S91.
9) Lipworth BJ. Targets for inhaled treatment. Respir Med 2000; 94(Suppl D):S13-S16.
10) Dolovich MA. Influence of inspiratory flow rate, particle size, and airway caliber on aerosolized drug delivery to the lung. Respir Care 2000; 45(6):597-608.
11) Fuller HD, Dolovich M, Chambers C, Newhouse MT. Aerosol delivery during mechanical ventilation:A predictive in-vitro lung model. J Aerosol Med 1992; 5:251-9.
12) Gibbs MA, Camargo CA (Jr), Rowe BH, Silverman RA. State of the art:Therapeutic controversies in severe acute asthma. Acad Emerg Med 2000; 7(7):800-15.
13) Newman SP, Clarke SW. Therapeutic aerosols 1. Physical and practical considerations. Thorax 1983; 38(12):881-6.
14) Rubin BK, Fink JB. Aerosol therapy for children. Respir Care Clin North Am 2001; 7(2):175-213.
15) Hess D, Fisher D, Williams P, Pooler S, Kacmarek RM. Medication nebulizer performance:effects of diluent volume, nebulizer flow, and nebulizer brand. Chest 1996; 110(2):498-505.
16) Alvine GF, Rodgers P, Fitzsimmons KM, Ahrens RC. Disposable jet nebulizers. How reliable are they? Chest 1992; 101(2):316-9.
17) Loffert DT, Ikle D, Nelson HS. A comparison of commercial jet nebulizers. Chest 1994; 106(6):1788-93.
18) Everald ML, Hardy JG, Milner AD. Comparison of nebulized aerosol deposition in the lungs of healthy adults following oral and nasal inhalation. Thorax 1993; 48(10):1045-6.
19) Jasper AC, Mohsenifar Z, Kahan S, Goldberg HS, Koerner SK. Cost-benefit comparison of aerosol bronchodilator delivery methods in hospitalized patients. Chest 1987; 91(4):614-8.
20) Bowton DL, Goldsmith WM, Haponik EF. Substitution of metered-dose inhalers for hand-held nebulizers. Success and cost savings in a large acute-care hospital. Chest 1992; 101(2):305-8.
21) O'Callaghan C. In vitro performance of plastic spacer devices (review). J Aerosol Med 1997; 10(Suppl 1):S31-S35.
22) Barry PW, O'Callaghan C. The effect of delay, multiple actuations and spacer static charge on the in vitro delivery of budesonide from the nebuhaler. Br J Clin Pharmacol 1995; 40(1):76-8.
23) Beveridge RC, Grunfeld AF, Hodder RV, Verbeek PR. Guidelines for the emergency management of asthma in adults. Can Med Assoc J 1996; 155(1):25-37.
24) British asthma guidelines coordinating committee. British guidelines on asthma management:1995-review and position statement. Thorax 1997; 52:S1-S24.
25) National Asthma Education and Prevention Program Expert Panel Report-2. Guidelines for the diagnosis and management of asthma. Bethesda:NIH, Publication, 1977:55-4051.
26) Travers A, Jones AP, Kelly K, Barker SJ, Camargo CA, Rowe BH. Intravenous beta2-agonists for acute asthma in the emergency department (Cochrane Review). In:The Cochrane Library, Issue 4, 2001. Oxford Update Software. Oxford:Cochrane Foundation, 2001. [Programa infromático].
27) Rodrigo G, Rodrigo C. Assessment of the patient with acute asthma in the emergency department. A factor analytic study. Chest 1993; 104(5):1325-8.
28) Rodrigo GJ, Rodrigo C. A new index of early prediction of hospitalization in patients with acute asthma. Am J Emerg Med1997; 15:8-13.
29) Rodrigo C, Rodrigo GJ. Therapeutic response patterns to high and cumulative doses of salbutamol in acute severe asthma. Chest 1998; 113:593-8.
30) Rodrigo GJ, Rodrigo C. Metered dose inhaler salbutamol treatment of asthma in the ED:comparison of two doses with plasma levels. Am J Emerg Med 1996; 14:144-50.
31) McFadden ER (Jr), Elsanadi N, Dixon L, Takacs M, Deal EC, Boyd KK, et al:Protocol therapy for acute asthma:therapeutic benefits and cost savings. Am J Med 1995; 99(6):651-61.
32) Strauss L, Hejal R, Galan G, Dixon L, McFadden ER Jr. Observations of the effects of aerosolized albuterol in acute asthma. Am J Respir Crit Care Med 1997; 155(2):545-8.
33) Papo MC, Frank J, Thompson AE. A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children. Crit Care Med 1993; 21(10):1479-86.
34) Khine H, Fuchs SM, Saville Al. Continuous vs intermittent nebulized albuterol for emergency management of asthma. Acad Emerg Med 1996; 3(11):1019-24.
35) Colacone A, Wolkove N, Stern E, Afilalo M, Rosenthal TM, Kreisman H. Continuous nebulization of albuterol (Salbutamol) in acute asthma. Chest 1990; 97(3):693-7.
36) Lin RY, Sauter D, Newman T, Sirleaf J, Walters J, Tavakol M. Continuous versus intermittent albuterol nebulization in the treatment of acute asthma. Ann Emerg Med 1993; 22(12):1847-53.
37) Rudnitsky GS, Eberlein RS, Schoffstall JM, Mazur JE, Spivey WH. Comparison of intermittent and continuously nebulized albuterol for treatment of asthma in an urban emergency department. Ann Emerg Med 1993; 22(12):1842-6.
38) Reisner C, Kotch A, Dworkin G. Continuous versus frequent intermittent nebulization of albuterol in acute asthma:a randomized, prospective study. Ann Allergy Asthma Immunol 1995; 75(1):41-7.
39) Shrestha M, Bidadi K, Gourlay S, Hayes J. Continuous vs intermittent albuterol, at high and low doses, in the treatment of severe asthma in adults. Chest 1996; 110(1):42-7.
40) Besbes-Ouanes L, Nouira S, Elatrous S, Knani J, Boussarsar M, Abroug F. Continuous versus intermittent nebulization of Salbutamol in acute severe asthma. A randomized, controlled trial. Ann Emerg Med 2000; 36(3):198-203.
41) Rodrigo GJ, Rodrigo C. Continuous vs intermittent beta-agonists in the treatment of acute adult asthma:A systematic review with meta-analysis. Chest 2002; 122(1):160-5.
42) Koning P. Spacer devices used with meter-dose inhalers:Breakthrough or gimmick? Chest 1985; 88:276-84.
43) Wildhaber JH, Dore ND, Wilson JM, Devadason SG, LeSouef PN. Inhalation therapy in asthma:nebulizer or pressurized meter-dose inhaler with holding chamber? In vivo comparison of lung deposition in children. J Pediatr 1999; 135(1):28-33.
44) Turner MO, Patel A, Ginsburg S, FitzGerald JM. Bronchodilator delivery in acute airflow obstruction. A meta-analysis. Arch Intern Med 1997; 157(15):1736-44.
45) Cates CJ, Rowe BH. Holding chambers versus nebulisers for beta-agonist treatment of acute asthma (Cochrane Review). The Cochrane Library, Issue 4, 2001. Oxford. Update Software.Oxford:Cochrane Foundation, 2001. [Programa infromático].
46) Rodrigo GJ, Rodrigo C. Comparison of salbutamol delivered by nebulizer or metered-dose inhaler with a pear-shaped spacer in acute asthma. Curr Ther Res 1993; 54:797-808.
47) Rodrigo C, Rodrigo GJ. Salbutamol treatment of acute severe asthma in the ED:MDI versus hand-held nebulizer. Am J Emerg Med 1998; 16(7):637-42.
48) Newhouse MT. Asthma therapy with aerosols:are nebulizers obsolete? A continuing controversy. J Pediatr 1999; 135(1):5-8.
49) Kung M, Croley SW, Phillips BA. Systemic cardiovascular and metabolic effects associated with the inhalation of an increased dose of albuterol:influence of mouth rinsing and gargling. Chest 1987; 91(3):382-7.
50) Jerrard DA, Olshaker J, Welebob E, Caraballo V, Hooper F. Efficacy and safety of a rapid-sequence metapro-terenol protocol in the treatment of acute adult asthma. Am J Emerg Med 1995; 13(4):392-5.
51) Brown MI, Brown DC, Murphy MB. Hypokalemia from beta2-receptor stimulation by circulating epinephrine. N Engl J Med 1983; 309:1414-9.
52) Scheinin M, Koulu M, Laurikainen E, Allonen H. Hypokalemia and other nonbronchial effects of inhaled fenoterol and Salbutamol:a placebo controlled dose-response study in healthy volunteers. Br J Clin Pharmacol 1987; 24(5):645-53.
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Publicado
2003-05-30
Cómo citar
1.
Rodrigo GJ, Rodrigo C. Tratamiento inhalatorio en la crisis asmática severa. Rev. Méd. Urug. [Internet]. 30 de mayo de 2003 [citado 12 de mayo de 2024];19(1):14-6. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/952
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Trabajos de Revisión o Actualización y Puestas al día
